Tag Archives: Dyspepsia

Main Clinical Manifestations of Chronic Cholecystitis

Chronic cholecystitis denotes persistent, low-grade inflammation of the gall-bladder wall, usually in the setting of recurrent mechanical irritation by gallstones or, less commonly, chronic infection or metabolic deposition. Symptoms are episodic and less dramatic than those of acute cholecystitis, but they may culminate in fibrosis, loss of function, or acute exacerbation.

  1. Recurrent biliary colic
    Episodic, post-prandial right-upper-quadrant or epigastric pain lasting 15–60 min, often precipitated by fatty foods and radiating to the inter-scapular region or right shoulder. Pain is typically self-limiting but becomes more frequent over time.
  2. Dyspeptic syndrome
    Early satiety, eructation, bloating, and nausea reflect impaired gall-bladder emptying and coexist with colicky episodes.
  3. Fat intolerance
    Patients report loose stools or diarrhoea following meals rich in fat, attributable to inadequate bile acid delivery to the duodenum.
  4. Vague upper-abdominal discomfort
    A dull, non-colicky heaviness or fullness persists between attacks, especially when the gall-bladder is distended by viscous bile or sludge.
  5. Tender hepatomegaly
    The liver edge remains smooth and mildly tender; the gall-bladder fundus may be palpable as a soft, non-distended mass that moves with respiration.
  6. Laboratory changes
    Serum alkaline phosphatase and γ-glutamyl transferase may be intermittently elevated; total bilirubin is usually normal unless common bile-duct stones coexist. Repeated episodes can raise C-reactive protein minimally.
  7. Acute exacerbation
    Sudden intensification of pain, high fever, or guarding signals progression to acute cholecystitis, gangrene, or empyema and mandates urgent evaluation.
Symptom / SignTypical Presentation
Recurrent colicPost-prandial RUQ pain 15–60 min, fatty trigger
DyspepsiaEarly satiety, bloating, eructation
Fat intoleranceLoose stools after rich meals
Vague discomfortDull heaviness between attacks
Tender organSoft, mildly tender gall-bladder edge
LaboratoryIntermittent ↑ ALP/GGT, normal bilirubin
ExacerbationSudden severe pain, fever, guarding

Related articles：

  1. Main Clinical Manifestations of Acute Cholecystitis
  2. Main Clinical Manifestations of Hepatic Hydatid Disease
  3. Main Clinical Manifestations of Extrahepatic Bile-Duct Stones
  4. Main Clinical Manifestations of Cholangitis
  5. Main Clinical Manifestations of Bile-Duct Stones
  6. Main Clinical Manifestations of Biliary Tract Diseases

Main Clinical Manifestations of Hepatic Hydatid Disease

Hepatic hydatid disease (hepatic echinococcosis) is a zoonotic infection caused by the larval stage of Echinococcus granulosus or E. multilocularis. Its presentation is dictated by cyst number, size, location, integrity, and associated complications. Many patients remain asymptomatic for years; symptoms emerge only when growing cysts exert a mass effect, rupture, or become secondarily infected.

  1. Pain and right-upper-quadrant discomfort
    A constant dull ache or sensation of fullness develops beneath the costal margin as the cyst expands or stretches Glisson’s capsule; sudden sharp pain heralds cyst rupture or intracystic haemorrhage.
  2. Palpable hepatic mass
    Inspection reveals asymmetric abdominal bulging; palpation detects a smooth, resilient, ballotable mass that moves with respiration and is dull to percussion.
  3. Dyspeptic complaints
    Early satiety, eructation, nausea and occasional vomiting occur when a large cyst compresses the stomach or duodenum.
  4. Jaundice and cholestasis
    Obstruction of segmental bile ducts by daughter cysts or external compression of the common hepatic duct produces fluctuating conjugated hyper-bilirubinaemia, dark urine and pale stools.
  5. Acute hypersensitivity phenomena
    Leakage or spontaneous rupture releases antigen-rich cyst fluid, provoking urticaria, pruritus, eosinophilia, or life-threatening anaphylaxis with hypotension and bronchospasm.
  6. Secondary infection and suppuration
    Fever, rigors and right-upper-quadrant tenderness appear when bacteria colonise the cyst, converting it into an abscess; laboratory studies show leucocytosis and raised C-reactive protein.
  7. Vascular and biliary fistulae
    Rupture into the biliary tree causes cholangitis, recurrent pyrexia and Charcot triad; communication with the portal vein or hepatic artery may lead to acute haemobilia with melena and anaemia.
  8. Systemic features
    Chronic weight loss, fatigue and low-grade fever reflect long-standing inflammation and diminished oral intake.
  9. Parasitic dissemination
    Implantation of protoscolices along the peritoneal or pleural surfaces produces secondary cysts, presenting months or years later as abdominal masses or pleural nodules.
Symptom / SignTypical Presentation
RUQ painDull ache; sudden if rupture/haemorrhage
Palpable massSmooth, ballotable, moves with respiration
DyspepsiaEarly satiety, nausea, eructation
JaundiceFluctuating; daughter-cyst obstruction
HypersensitivityUrticaria, pruritus, eosinophilia, anaphylaxis
Secondary infectionFever, rigors, tenderness, leucocytosis
Biliary fistulaCholangitis, Charcot triad, haemobilia
SystemicWeight loss, fatigue, low-grade fever
DisseminationSecondary peritoneal or pleural cysts

Related articles：

  1. Main Clinical Manifestations of Hepatic Abscess
  2. Main Clinical Manifestations of Hepatic Ascites
  3. Main Clinical Manifestations of Hepatic Rupture
  4. Main Clinical Manifestations of Hilar Cholangiocarcinoma
  5. Main Clinical Manifestations of Congenital Biliary Malformations
  6. Main Clinical Manifestations of Acute Cholecystitis